Pneumonia in a nursing home.

The authors studied nursing home residents serologically to determine whether atypical organisms were causes of radiologic pneumonia. The study was conducted at the Wisconsin Veterans Home, a facility with on-site microbiology and x-ray. Over one year, serologic examinations for Legionella, Mycoplasma, and Chlamydia were conducted for the residents who had pneumonia. Cultures and mortality were reviewed. Fifty-six episodes were studied (mean resident age 78 years). There was no fourfold titer change. Seventeen quality sputum specimens revealed Streptococcus pneumoniae (5), normal flora (4), Hemophilus influenzae (4), Moraxella catarrhalis (3), Staphylococcus aureus (1), and beta-hemolytic Streptococcus, not group A (1). The two-month mortality was 21%. This study did not result in serologic confirmation of atypical organisms' causing pneumonia. Antibiotic choice should be based on coverage of prevalent organisms, including Hemophilus influenzae, Moraxella, and Staphylococcus, as well as clinical features.

Asthma and chlamydial infection: a case series.

BACKGROUND: Adult-onset asthma is frequently associated with antecedent respiratory symptoms that could represent either previously undiagnosed asthma or previous lung infections that result in subsequent asthma. To further investigate a reported association of Chlamydia pneumoniae infection and adult reactive airway disease, we looked for evidence of atypical infections in patients with acute wheezing and nonwheezing respiratory illnesses. METHODS: Pharyngeal cultures and acute and convalescent serology for C pneumoniae and Mycoplasma pneumoniae were obtained from 131 primary care outpatients (mean age, 36 years) with acute wheezing or nonwheezing respiratory illnesses. Peak flow measurements were obtained in patients with cough or wheeze. Spirometry before and after bronchodilator use was obtained to substantiate the diagnosis of chronic asthma in patients who had persistent wheezing and dyspnea after enrollment. RESULTS: Twelve (9.2%) of 131 patients were classified as having chronic asthma, 5/12 developed chronic asthma for the first time during the study period. Thirty (22.9%) patients were classified with acute asthmatic bronchitis, and 89 (67.9%) had nonwheezing illness. Two of the newly diagnosed asthmatics met serologic criteria for acute C pneumoniae infection, and one had serologic evidence for acute M pneumoniae infection. Compared with patients with nonwheezing respiratory illnesses, C pneumoniae seroreactivity was significantly (P < .001) associated with both chronic asthma and with acute asthmatic bronchitis. CONCLUSIONS: Acute wheezing illness was encountered frequently in this primary care setting. Although most acute wheezing respiratory illness resolved without obvious chronic sequelae, some patients had persistent symptoms and were diagnosed with chronic asthma. C pneumoniae seroreactivity was associated with both acute and chronic wheezing, suggesting that pulmonary infection with this intracellular pathogen plays a role in the natural history of reactive airway disease.

Smoking is a potential confounder of the Chlamydia pneumoniae-coronary artery disease association.

Two recent studies, which did not adequately control for smoking status, found associations between Chlamydia pneumoniae serological titers and various manifestations of coronary artery disease (CAD). The validity of C. pneumoniae-CAD associations found in case-control studies has been criticized on the basis that smoking, known to be associated with CAD and hypothesized to be associated with C. pneumoniae seroreactivity via an increased prevalence of respiratory infection in smokers, could be an uncontrolled confounder in these studies. We investigated associations between current smoking status and C. pneumoniae serological titers in a cohort of 365 outpatients (mean age, 34 years) with respiratory illness. Current smokers were significantly (p = 0.04) more likely than nonsmokers to have C. pneumoniae titers greater than or equal to 1:128, and there was a significant (p less than 0.05) "dose-response" association between titer category and smoking, which persisted after controlling for age and sex in a logistic-regression model. These results support the hypothesis that smoking may be a confounder of the association of C. pneumoniae antibody titer and smoking-associated diseases such as CAD. Future studies into these associations should control for cigarette use.

Association of Chlamydia pneumoniae (strain TWAR) infection with wheezing, asthmatic bronchitis, and adult-onset asthma.

UNLABELLED: OBJECTIVE--To study the clinical characteristics of respiratory tract illness caused by Chlamydia pneumoniae. DESIGN: -Prospective clinical, bacteriologic, and serologic study. Secondarily, a matched comparison of patients with and without evidence of C pneumoniae infection (serologic titers greater than or equal to 1:64 and less than 1:16, respectively). SETTING: --Four primary care (family practice) clinics in Madison, Wis, and nearby towns. PATIENTS: --The study included 365 white males and females (mean age, 34.2 years). MAIN OUTCOME MEASURES: --Association of acute C pneumoniae infection with signs and symptoms of respiratory illness and the relationship of C pneumoniae antibody titer with wheezing at the time of enrollment in the study, and with the diagnosis of asthmatic bronchitis. RESULTS: --Nine (47%) of 19 patients with acute C pneumoniae infection had bronchospasm during respiratory illness, and there was a strong quantitative association of C pneumoniae titer with wheezing at the time of enrollment in the study (P = .01). In the matched study, C pneumoniae antibody was significantly associated with asthmatic bronchitis after, but not before, respiratory illness (odds ratio, 7.2; 95% confidence interval, 2.2 to 23.4). Four infected patients had newly diagnosed asthma after illness, and four others had exacerbation of previously diagnosed asthma. There was no serologic evidence of coexisting Mycoplasma pneumoniae, Chlamydia trachomatis, or respiratory viral infection in 96% of patients with asthmatic bronchitis and asthma. CONCLUSIONS: --Some C pneumoniae antibody titers, although not diagnostic of chlamydial infection by present criteria, probably represent acute reinfection or ongoing chronic infection. Repeated or prolonged exposure to C pneumoniae may have a causal association with wheezing, asthmatic bronchitis, and asthma.

HIV seroprevalence and the acceptance of voluntary HIV testing among newly incarcerated male prison inmates in Wisconsin.

In 1986-88, voluntary and blinded HIV testing was conducted among Wisconsin male prison entrants. The HIV seroprevalence was 0.30 percent in 1986, 0.53 percent in 1987, and 0.56 percent in 1988. The seroprevalence rates among entrants tested voluntarily did not differ from those tested blindly. Voluntary HIV testing was accepted by 71 percent of male prison entrants in 1988; among entrants reporting intravenous drug use 83 percent consented to voluntary HIV testing. Voluntary HIV testing of entrants appears to be an effective screening strategy in Wisconsin prisons.

Chlamydia trachomatis infection in women attending urban midwestern family planning and community health clinics: risk factors, selective screening, and evaluation of non-culture techniques.

To determine prevalence and risk factors for endocervical Chlamydia trachomatis infection in an urban midwestern population and to evaluate two non-culture direct tests for C. trachomatis, we studied 849 women attending two family planning clinics and a community health clinic in Milwaukee, Wisconsin. Adequate endocervical specimens were obtained from 751 women for chlamydial isolation in tissue culture and antigen tests using direct fluorescence (DFA) and enzyme immunoassay (EIA); 93 (12.4%) patients had cultures positive for C. trachomatis. Compared to culture, the DFA test had a 77.4% sensitivity, 96.8% specificity, and a predictive value positive (PVP) of 77%. For the EIA, these values were 83.9%, 97.0%, and 80%, respectively. No single historical, clinical, or laboratory variable, including the previously described cervicitis index and specific cytologic findings on Pap smear, had sufficient predictive value to be used as the only criterion for selective screening in this population. Criteria for selective screening were proposed that would result in screening 43% of patients and would identify 71% of infections. PVP of both non-culture tests was 89% in persons identified by these criteria to be at increased risk of C. trachomatis infection.

Changes in T-lymphocyte distribution associated with ingestion of aldicarb-contaminated drinking water: a follow-up study.

The carbamate pesticide, aldicarb, is the most commonly found man-made groundwater contaminant in Wisconsin. A 1985 study linked ingestion of aldicarb-contaminated drinking water with altered T-cell distributions, specifically an increase in the mean number of CD8+ (T8) T cells. To further evaluate this finding, a follow-up study was done in 1987. Of the 50 Portage County, Wisconsin, women who participated in the first study, 45 participated in the follow-up: 18 formerly exposed and 27 formerly unexposed. In our follow-up study, only 5 women were found to be currently exposed to aldicarb. This group of 5 women, compared to 39 unexposed women who had peripheral blood specimens taken, had an increased percentage of lymphocytes and an increased number of CD2+ T cells, due to an increased number of total CD8+ T cells. Although the number of exposed persons was small, the increases in percentage lymphocytes and absolute numbers of CD2+ and CD8+ T cells were consistent with a dose-response relationship. No identified drinking water contaminant other than aldicarb could explain these findings. These results support earlier evidence linking aldicarb exposure and lymphocyte distribution changes. Although adverse clinical effects have not been documented, the widespread use of this chemical and consequent potential for widespread exposure indicate a clear need for further research on this issue.

Absence of infection with human immunodeficiency virus in Peruvian prostitutes.

We serologically tested 140 female prostitutes (mean age, 30 years) from the port city of Callao, Peru, for evidence of infection with human immunodeficiency virus (HIV), Chlamydia trachomatis, Treponema pallidum, herpes simplex viruses (HSV) I and II, and hepatitis B virus. The women had worked as prostitutes for an average of 5 years; one-fourth serviced foreign visitors exclusively, mainly sailors. Only 4 women used condoms, and only 1 woman gave a history of parenteral narcotic abuse, although 53% were regularly exposed to unsterile needles outside the medical setting for injections of vitamins, antibiotics, or steroids; another 29% are thought to probably use unsterile needles. None of the 140 prostitutes screened was seropositive for HIV, despite a very high prevalence of antibody to T. pallidum (24%), C. trachomatis (97%), HSV I and II (100%), and hepatitis B (51%); 5% were HbsAg positive. These data indicate that HIV has not yet been introduced into female prostitutes in the Peruvian port city. We believe that widespread use of unsterile needles in developing countries, such as Peru, represents a serious health threat and will amplify the spread of HIV, once introduced.

Human immunodeficiency virus seroprevalence and drug-using behavior in Milwaukee intravenous drug abusers.

We assessed human immunodeficiency virus (HIV) antibody prevalence and drug-using behaviors among intravenous drug abusers (IVDAs) enrolled in Milwaukee drug treatment programs. Six (2.3%) of 266 study participants were positive for HIV antibody by Western blot assay. A history of needlesharing was reported by 91% of participants, injection of drugs within the past 6 months by 76%, visits to a shooting gallery by 34%, and drug injection outside of Wisconsin by 41%. Nonwhite participants were more likely than white participants to share needles greater than 5 times per month (odds ratio of 2.0) and more likely to have visited a shooting gallery greater than 5 times (odds ratio of 2.7). The average frequency of injection did not differ significantly by race or gender. Pharmacies were the most frequently listed source of sterile needles, and the most common reason for sharing needles was convenience. We conclude that as of late 1987, HIV seroprevalence in Milwaukee IVDAs remained relatively low compared to that of IVDAs in the northeastern United States. There may be racial differences in drug-using behaviors that define distinct subpopulations of IVDAs. These differences should be assessed further, since they have important implications for the success of AIDS education efforts.

Chronic exposure to aldicarb-contaminated groundwater and human immune function.

Aldicarb, a carbamate pesticide, has been a known groundwater contaminant in Wisconsin since 1981. To assess the effects of chronic ingestion of low-level aldicarb-contaminated groundwater (less than 61 ppb) on the immune function of humans, we identified 50 women, ages 18 to 70, with no known underlying reason for immunodysfunction. Twenty-three of these women (exposed group) consumed groundwater with detectable levels of aldicarb, and 27 (unexposed group) consumed water from a source with no detectable levels of aldicarb. Data were collected on each woman's health status, immune function, and fluid intake. Exposed women as compared with unexposed women showed an elevated stimulation assay response to the antigen Candida (P less than 0.02, t test). The exposed group had increased numbers of T8 cells (P less than 0.05, t test), an increased percentage of total lymphocytes as T8 cells (P less than 0.02, t test), and a decreased ratio of T4:T8 cells (P less than 0.02, t test). Our results suggest an association between consumption of aldicarb-contaminated groundwater and abnormalities in T-cell subsets in women with otherwise intact immune systems.

Diagnosis of HTLV-III infection by ultrastructural examination of germinal centers in lymph node--a case report.

Serum from a patient suspected of having AIDS showed positive ELISA tests but the diagnostic p 41 band was absent and the p 24 band was barely discernible on a Western blot. Before another Western blot was performed lentivirions were detected between dendritic reticulum cells in a lymph node biopsy. It is suggested that samples of biopsies of lymph nodes from patients with or at risk for AIDS should be embedded in resin for future ultrastructural study if indicated.

Detection of infectious mononucleosis heterophil antibody by a rapid, standardized enzyme-linked immunosorbent assay procedure.

A rapid, specific, sensitive, standardized, a reproducible enzyme-linked immunosorbent assay (ELISA) procedure has been developed for detecting the heterophil antibody associated with infectious mononucleosis (IM). The IM heterophil antibody used for the solid phase was purified from bovine erythrocyte stroma. The test uses heavy-chain-specific anti-immunoglobulin M (IgM) labeled with alkaline phosphatase and three 10-min incubations. The quantitative results correlated well with horse erythrocyte agglutination titers. Absorption tests confirmed the specificity of the ELISA reactions for IM heterophil antibodies. Neither very high levels of IgM in myeloma sera nor high levels of rheumatoid factor caused false-positive reactions. A number of probable IM cases were encountered which positive by ELISA but negative by the horse erythrocyte slide agglutination test. Absorption studies indicated that these were true-positives for the IM heterophil antibody. The IM heterophil antibodies were confirmed to be predominantly of the IgM class, but moderate proportions of the IgM class were sometimes encountered.

Maternal serum diamine oxidase in fetal death and low-birth-weight infants.

Serum diamine oxidase was measured at different gestational ages in 681 pregnancies resulting in live births and 102 pregnancies resulting in fetal deaths. Statistical analysis revealed that gestational age-adjusted diamine oxidase levels in the fetal-death group were significantly lower (P less than 0.001) than those in the live-birth group. Moreover, the relative risk associated with a low diamine oxidase level, compared with a normal level, increased from 3.7 at 8 weeks to 16.6 at 12 weeks. Pregnancies resulting in low-birth-weight infants exhibited normal serum diamine oxidase levels. The association between low diamine oxidase and subsequent fetal death is discussed in view of the hypothesis that polyamines and polyamine-degrading enzymes interact to protect the fetoplacental unit from immune rejection.

Chlamydial prostatitis in dogs: an experimental study.

Ten adult male mongrel dogs were inoculated with Chlamydia trachomatis by injections of 10(6) or 10(7) organisms directly into the prostate. We were able to recover Chlamydia 3 to 7 days later in three of four dogs receiving injections of 10(7) organisms. Eight of ten dogs developed detectable serum antibody to Chlamydia 14 to 68 days following inoculation. All dogs receiving 10(7) Chlamydia and two of six dogs receiving 10(6) organisms developed histological signs of prostatic hyperplasia. Thus, the dog may be a model for establishment of chlamydial prostatitis and may be used for further investigations of this disease.

Clinical evaluation of a single antibody RIA assay for alpha-fetoprotein.

Open neural tube defects have been associated with elevated levels of alpha-fetoprotein in maternal serum and amniotic fluid. In the present study, specimens were collected during 14 to 20 weeks of gestation in five laboratories. Dates were confirmed by ultrasound. Among 1,049 subjects included in total serum alpha-fetoprotein determinations, 25 infants were born with neural tube defects, one patient had intrauterine fetal demise, and 1,023 delivered normal infants. The false-negative rate for serum alpha-fetoprotein was 0.38%, and the false-positive rate was 0.29%. For the total 1,211 amniotic fluid specimens, 23 infants were born with neural tube defects. The false-negative rate for amniotic fluid alpha-fetoprotein was 0.25%. All were closed lesions. There were no false-positive values. This study reaffirms the value of screening for neural tube defects by means of serum alpha-fetoprotein RIA. It also negates the argument that serum screening would promote excessive amniocentesis.

Hepatitis-B surface antigen and antibody: prevalence and persistence in institutionalized and noninstitutionalized persons.

A total of 426 persons were studied in an attempt to more clearly define the high prevalence of hepatitis-B surface antigen (HBsAg) seen among institutionalized persons. HBsAg was found in 63.4 percent of the children and young adults with Down's syndrome (DS) at the Central Wisconsin Center (CWC) and in 45.5 percent of those at the Northern Wisconsin Center (NWC). Significantly more subjects with DS had hepatitis-B antigenemia than age- and sex-matched non-DS institutionalized subjects. Antibody (anti-HBs) to HBsAg was found in 19.5 percent of the DS subjects at CWC and in 38.6 percent of those at NWC. The prevalence of anti-HBs was similar among DS and non-DS institutionalized subjects. None of the noninstitutionalized subjects had HBsAg in their serums and their anti-HBs prevalence was low (2.1 percent). HBsAg was found to persist for at least 10 years in both DS and non-DS institutionalized subjects. However, persistence occurred more frequently among DS subjects. Anti-HBs persisted at least 10 years among non-DS subjects, but DS subjects tended to lose antibody sooner. The study findings indicated that the high prevalence of HBsAg seen in institutionalized DS subjects at CWC and NWC were not related to the age of the subject at admission nor to the duration of institutionalization.

Comparative study of antistreptolysin O, antideoxyribonuclease B and multienzyme tests in streptococcal infections.

The results of antistreptolysin O (ASO), antideoxyribonuclease B (ADB), and a multienzyme test, Streptozyme, with 162 sera from a stratified random sample of Wisconsin school children, and specimens routinely submitted for serodiagnosis of Group A streptococcal infections are described. A review of the results of Streptozyme tests of laboratories participating in the State Division of Health Proficiency Testing Program, is also presented. The results of these various tests have revealed both false positive and false negative results with the Streptozyme procedure. Although there was good correlation of the Streptozyme findings with the ASO and ADB tests results with sera from young children, false positive Streptozyme test results increased with age of the study subjects. Our results with the ADB test on sera from apparently normal Wisconsin children and young adults suggest that the upper limits of normal ADB values, suggested by the manufacturers of commercial ADB test kits, may be too low.

A study of Cytomegalovirus, Epstein-Barr virus and Herpesvirus hominis (types 1 and 2) antibody in institutionalized and non-institutionalized children.

In an attempt to demonstrate differences in antibody prevalence between free-living and institutionalized children, antibodies to Cytomegalovirus (CMV), Epstein-Barr virus (EBV), and Herpesvirus hominis (HVH), types 1 and 2, were assayed in 123 children. The children comprised three groups consisting of 41 institutionalized patients with Down's syndrome (all non-disjunctive trisomy-G karyotype and equal numbers of age-, sex-, and race-matched non-mongoloid institutionalized subjects and non-institutionalized normal controls. CMV antibody titer values were statistically similar in the three groups. However, fewer mongoloids (21.9%) were seropositive than other institutionalized retardates (39.0%) and normal control subjects (43.9%). Antibody titer values to EBV were also similar; however, in comparison to the other groups, significantly more mongoloids were seropositive at younger ages. More mongoloids were seropositive to HVH-1 and had higher antibody titers than the other two groups. Antibody to HVH-2 was more prevalent in institutionalized subjects, 85.4% in mongoloids and 65.8% in other institutionalized retardates, than in normal non-institutionalized children (26.8%).